Contribution of individual drugs to gingival overgrowth in adult and juvenile renal transplant patients treated with multiple therapy

Abstract. Drug regimens for transplantation often consist of multiple therapeutic agents and may result in drug-induced gingival overgrowth (DIGO). The aim of this study was to investigate the contribution of individual drugs in renal transplant patients. 147 adults (19–84 years) and 60 juveniles (3–18 years) were scored for DIGO and other clinical variables. Duration of treatment, dosage of drugs per kg body weight and serum cyclosporin levels were recorded. 44% of adults and 27% of children had DIGO. All patients were receiving prednisolone. More adults than children were administered cyclosporin, the reverse was true of azathioprine ( P 0.01), Explanatory models were evaluated by stepwise ordinal polynomial logistic regression. Statistically significant explanation ( P 0.05) of DIGO was afforded by prednisolone, nifedipine and azathioprine concentrations in adults and by cyclosporin, nifedipine and azathioprine concentrations in juveniles. Prednisolone and azathioprine were inversely related to the degree of DIGO. Plaque and irregularity scores, lip coverage and mouthbreathing status showed significant additional explanation in adults, replacing nifedipine and azathioprine in the final model. Irregularity was additionally explanatory in children, but no other clinical variables. A larger proportion of the variance of DIGO was explained by the available variables in children than in adults (pseudo r ²=0.50 versus 0.25). The degree of DIGO in renal transplant patients is influenced by the dosage of a number of individual components of multiple drug therapy independently of the presence of local clinical factors.     

Reduction of silver complexes: towards an ever more elaborated insight in the influence of the type of ligand on the reaction rate

The present work deals with the investigation of the electrochemical reduction of silver thiosulphate (1,2-Ag(S₂O₃)₂^3?), thiocyanate (1,3-Ag(SCN)₃^2?) and 1,8-dihydroxy-3,6-dithiaoctane (1,2-Ag(DTO)₂⁺) complexes. The influence of the ligand type on the charge transfer rate is explained by the changing positions of the density distributions of electronic energy levels of the three complexes. The basics for this approach are the theories of energy band models (EBMs). An experimental methodology is developed to determine the energy density distributions. A Ti/TiO₂ substrate, obtained by galvanostatically anodising Ti, is put forward as an appropriate substrate for this investigation, and its semiconducting properties are determined. On this substrate, charge transfer (CT) controlled currents can be measured in a sufficiently large potential domain for the three systems. A method of pre-plating is optimised such that the overall semiconducting character of the substrate is kept during the monitoring of the (quasi-)stationary current/voltage diagrams. The active surface areas, necessary for the calculation of the current density/potential curves, are calculated. The positions of the energy density distributions, obtained by the derivation of the current density/voltage diagrams, of the three complexes, show that thiosulphate exhibits the smallest density of accepting energy levels in the given potential domain. For potentials above 0.5 V vs. SCE, the DTO complex has the largest density of vacant energy levels, but for lower potentials the situation is reversed.     

非接触式三维图像检测系统测量牙齿咬合面磨损的初步研究

目的　使用新研制的非接触式三维图像检测系统对健康人牙齿咬合面的磨损情况进行定量测定。方法　选择 32名牙列完整的健康中老年人 5年前后的牙颌模型 ,用统一方法确定个体参照平面和上颌第一恒磨牙测量范围 ,用非接触式三维图像检测系统测量研究对象 5年内上颌第一恒磨牙咬合面的磨损量和平均磨损速度。结果　 5年内上颌第一恒磨牙咬合面的磨损情况 :以高度平均值变化为指标 ,平均磨损量为 0 2 93mm ,平均每年磨损速度为 0 0 5 9mm ;以体积变化为指标 ,平均磨损量为 97 881mm3 ,平均磨损速度为 19 5 76mm3 /年。结论　非接触式三维图像检测系统及相关的必要设置 ,可作为测量健康人牙齿磨损情况的有效工具。其个别设置条件尚待进一步改进     

Investigation on the shaping ability of nickel-titanium files when used with a reciprocating motion

Introduction

The introduction of nickel-titanium (NiTi) files into clinical practice has improved the quality of canal shaping, but increasing the curvature of the root canal (or the diameter of the master instrument that prepares the full working length) could result in more transportation, straightening, and aberration of the canal. Nickel-titanium instruments are significantly safer and have an extended cyclic fatigue life when used with a reciprocating movement. The purpose of this study was to compare the shaping ability of FlexMaster NiTi instruments when used in either continuous or reciprocating movements.

Methods

Thirty-two Endo Training Blocks ISO 15, 2% taper, 10-mm radius of curvature, and 70° angle of curvature were prepared, according to the group, with FlexMaster NiTi instruments either in continuous rotation or in reciprocating (60° clockwise, 40° counterclockwise) movement. Preoperative and postoperative images of the simulated canals were taken under standardized conditions. The preoperative and postoperative images were combined exactly. The amount of resin removed was determined both for the inner (convex) and the outer (concave) sides of the curvature at 10 different points.

Results

In the most apical third of the canal, the Continuous group produced the largest enlargement of the canal as compared with the Reciprocating group (P < .05). In the apical third, the Continuous group displayed significantly greater enlargement of the canal at the external side.

Conclusions

The shaping of simulated canals is more centered by using a reciprocating motion when compared with continuous rotation, but the reciprocating motion could be more time-consuming.     

Ocular blood flow as a clinical observation: Value,limitations and data analysis

Alterations in ocular blood flow have been identified as important risk factors for the onset and progression of numerous diseases of the eye. In particular, several population-based and longitudinal-based studies have provided compelling evidence of hemodynamic biomarkers as independent risk factors for ocular disease throughout several different geographic regions. Despite this evidence, the relative contribution of blood flow to ocular physiology and pathology in synergy with other risk factors and comorbidities (e.g., age, gender, race, diabetes and hypertension) remains uncertain. There is currently no gold standard for assessing all relevant vascular beds in the eye, and the heterogeneous vascular biomarkers derived from multiple ocular imaging technologies are non-interchangeable and difficult to interpret as a whole. As a result of these disease complexities and imaging limitations, standard statistical methods often yield inconsistent results across studies and are unable to quantify or explain a patient's overall risk for ocular disease.Combining mathematical modeling with artificial intelligence holds great promise for advancing data analysis in ophthalmology and enabling individualized risk assessment from diverse, multi-input clinical and demographic biomarkers. Mechanism-driven mathematical modeling makes virtual laboratories available to investigate pathogenic mechanisms, advance diagnostic ability and improve disease management. Artificial intelligence provides a novel method for utilizing a vast amount of data from a wide range of patient types to diagnose and monitor ocular disease. This article reviews the state of the art and major unanswered questions related to ocular vascular anatomy and physiology, ocular imaging techniques, clinical findings in glaucoma and other eye diseases, and mechanistic modeling predictions, while laying a path for integrating clinical observations with mathematical models and artificial intelligence. Viable alternatives for integrated data analysis are proposed that aim to overcome the limitations of standard statistical approaches and enable individually tailored precision medicine in ophthalmology.     

Impact of type of procedure and surgeon on EuroSCORE operative risk validation

Objective

EuroSCORE has been used in cardiac surgery operative risk assessment, despite important variables were not included. The objective of this study was to validate EuroSCORE on mortality prediction in a Brazilian cardiovascular surgery center, defining the influence of type of procedure and surgical team.

Methods

Between January 2006 and June 2011, 2320 consecutive adult patients were studied. According to additive EuroSCORE, patients were divided into low risk (score<2), medium risk (3 - 5), high risk (6 - 11) and very high risk (>12). The relation between observed mortality (O) and expected mortality (E) according to logistic EuroSCORE was calculated for each of the groups, types of procedures and surgeons with > 150 operations, and analyzed by logistic regression.

Results

EuroSCORE correlated to the observed mortality (O/E=0.94; P<0.0001; area under the curve 0.78). However, it overestimated the mortality in very high risk patients (O/E=0.74; P=0.001). EuroSCORE tended to overestimate isolated myocardial revascularization mortality (O/E=0.81; P=0.0001) and valve surgery mortality (O/E=0.89; P=0.007) and it tended to underestimate combined procedures mortality (O/E=1.09; P<0.0001). EuroSCORE overestimated surgeon A mortality (O/E=0.46; P<0.0001) and underestimated surgeon B mortality (O/E=1.3; P<0.0001), in every risk category.

Conclusion

In the present population, EuroSCORE overestimates mortality in very high risk patients, being influenced by type of procedure and surgical team. The most appropriate surgical team may minimize risks imposed by preoperative profiles.     

Disc size markedly influences concentration profiles of intravenously administered solutes in the intervertebral disc: a computational study on glucosamine as a model solute

Purpose

Tests on animals of different species with large differences in intervertebral disc size are commonly used to investigate the therapeutic efficacy of intravenously injected solutes in the disc. We hypothesize that disc size markedly affects outcome.

Methods

Here, using a small non-metabolized molecule, glucosamine (GL) as a model solute, we calculate the influence of disc size on transport of GL into rat, rabbit, dog and human discs for 10 h post intravenous-injection. We used transient finite element models and considered an identical GL supply for all animals.

Results

Huge effects of disc size on GL concentration profiles were found. Post-injection GL concentration in the rat disc reached 70 % blood concentration within 15 min but remained below 10 % in the human disc nucleus throughout. The GL rapidly penetrated post-injection into smaller discs resulting in homogeneous concentrations. In contrast, GL concentration, albeit at much lower levels, increased with time in the human disc with a small outward flux at the annulus periphery at longer periods.

Conclusions

Changes in the disc size hugely influenced GL concentrations throughout the disc at all regions and times. Increases in administered dose can neither remedy the very low concentration levels in the disc center in larger human disc at early post-injection hours nor alter the substantial differences in concentration profiles estimated among various species. The size effect will only be exacerbated as molecular weight of the solute increases and as the endplate calcifies. Extrapolation of findings from animal to human discs on the efficacy of intravenously administered solutes must proceed with great caution.     

基于中西医临床病症特点的膀胱炎动物模型分析

膀胱炎是泌尿系统最常见的疾病之一,临床患者主要表现为尿频、尿急、尿痛,也被称为“膀胱刺激三联征”,尤以女性多见。近年来,随着人们生活方式改变,我国膀胱疾病患病率逐年递增,该文根据膀胱炎中西医病因病机及临床病症的特点,查阅相关文献整理出临床诊断标准,通过对现有膀胱炎动物模型的分析,评价模型与临床表现吻合度,总结优缺点。发现“腹腔注射环磷酰胺”以及“弗氏完全佐剂+膀胱插管”具有较高吻合度,但也存在耗时长,费用高等不足之处。目前膀胱炎模型中诊断标准大多以西医检测指标为主,有关类型明确诊断依据还需依赖于膀胱镜检查+组织活检,因中医证候模型的缺乏也给中医药研究带来了局限性,且中医动物模型评价方法“四诊”因其易受主观因素影响,不能够很好的应用在动物模型上,可通过一些行为学测试来判定模型指标,制定相关行为参数评分量表。因此建立既符合西医临床病症特点也符合中医辨证的膀胱炎动物模型是当下所需,以更好地促进膀胱炎的研究。     

So what exactly is nursing knowledge?

This paper aims to present a discussion about intrinsic nursing knowledge. The paper stems from the author's study of knowledge claims enshrined in nursing journal articles, books and conference speeches. It is argued that claims by academic nurses have largely depended on principles drawn from continental and not Analytic (British-American) philosophy. Thus, claims are credible only insofar as they defer propositional logic. This is problematic inasmuch as nursing is a practice-based activity usually carried out in medical settings. Transpersonal nursing models are particularly criticizable in respect of their unworldly character as are also concepts based on shallow usages of physics or mathematics. I argue that sensible measurements of the 'real world' are possible--without endorsing positivism--and that nursing requires little recourse to logically unsustainable claims. The paper concludes with an analysis of a recent review of nursing knowledge, which analysis indicates the circularity that attends many discussions on the topic.